Increased Rate of Catheter‐Related Bloodstream Infection Associated With Use of a Needleless Mechanical Valve Device at a Long‐Term Acute Care Hospital •

Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC 29425, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 07/2007; 28(6):684-8. DOI: 10.1086/516800
Source: PubMed


To determine whether introduction of a needleless mechanical valve device (NMVD) at a long-term acute care hospital was associated with an increased frequency of catheter-related bloodstream infection (BSI).
For patients with a central venous catheter in place, the catheter-related BSI rate during the 24-month period before introduction of the NMVD, a period in which a needleless split-septum device (NSSD) was being used (hereafter, the NSSD period), was compared with the catheter-related BSI rate during the 24-month period after introduction of the NMVD (hereafter, the NMVD period). The microbiological characteristics of catheter-related BSIs during each period were also compared. Comparisons and calculations of relative risks (RRs) with 95% confidence intervals (CIs) were performed using chi (2) analysis.
Eighty-six catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during the study period. The rate of catheter-related BSI during the NMVD period was significantly higher than that during the NSSD period (5.95 vs 1.79 infections per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88-3.83]; P<.001). A significantly greater percentage of catheter-related BSIs during the NMVD period were caused by gram-negative organisms, compared with the percentage recorded during the NSSD period (39.5% vs 8%; P=.007). Among catheter-related BSIs due to gram-positive organisms, the percentage caused by enterococci was significantly greater during the NMVD period, compared with the NSSD period (54.8% vs 13.6%; P=.004). The catheter-related BSI rate remained high during the NMVD period despite several educational sessions regarding proper use of the NMVD.
An increased catheter-related BSI rate was temporally associated with use of a NMVD at the study hospital, despite several educational sessions regarding proper NMVD use. The current design of the NMVD may be unsafe for use in certain patient populations.

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Available from: Cassandra D Salgado, Aug 13, 2014
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    • "A retrospective multi-center study by Hetem et al. [10] showed a high rate of contamination of central venous catheters at different connection sites with Staphylococcus aureus; up to 12% of patients suffered from bacteremia after CVC removal. The contamination rate indicated in the trial of Casey et al. [11] with a contamination rate of 10% for the internal surfaces of TWC luers with standard caps correspond with the data obtained in our observation. It might be objected that our observation was not a prospective, randomized trial and reports only experience at a single institution. "
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    ABSTRACT: Many cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as "intervention"), we compared luer lock caps with a "closed access system" consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety). For determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n=1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation.Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination. With the closed access system, the mean working time of 5.5minutes could be reduced to 2.97minutes. The results for average process costs (labour and material costs per use) were 3.92 [euro sign] for luer lock caps and 2.55 [euro sign] for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value <0.05) confirmed the significance of the result.In 50 reviewed samples (TWC's), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%.Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%. In the present research, the closed access system with a divided split septum was superior to conventional luer lock caps. The advantage of the closed access system lies in the simplified handling for staff, which results in a reduced risk of patient infection due to improved clinical hygiene.
    BMC Infectious Diseases 01/2014; 14(1):41. DOI:10.1186/1471-2334-14-41 · 2.61 Impact Factor
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    • "In the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network report for 2010, the mean central lineassociated blood stream infection rate for a total of over 157,000 catheter days, from both freestanding LTACs and those within general acute care hospitals , was 1.3 per 1,000 catheter days. This rate is over 14-fold higher than that found in our study comprising 183,000 catheter days (Dudeck, et al., 2011; Munoz-Price, 2009; Salgado, Chinnes & Paczesny, 2007; Wolfenden, Anderson, Veledar & Srinivason, 2007). "
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